title: Multi-drug-resistant, non-fermenting, gram-negative bacilli in neonatal sepsis in Kolkata, India: a 4-year study.
abstract: BACKGROUND
  Non-fermenting gram-negative bacilli (NFGNB) are an emerging problem in neonatal sepsis. A major concern is multi-drug resistance which severely limits treatment options.
  
  
  OBJECTIVE
  A retrospective observational study was conducted to analyse the role of non-fermenters in neonatal sepsis over a 4-year period, the factors leading to this trend and the pattern of antibiotic resistance.
  
  
  METHODS
  Demographic and clinical data were collected for all neonates with blood culture-positive sepsis during the study period, January 2007 to December 2010.
  
  
  RESULTS
  Blood cultures were positive in 186 (13%) of 1402 neonates, in 44 (32.1%) of whom the cause was NFGNB. Acinetobacter spp was the most common organism (n = 30). Infection by NFGNB showed a steady increase (P<0.0001), and was fairly evenly distributed between early- and late-onset sepsis. The infection rate was significantly higher in inborn neonates (P = 0.04) and those delivered vaginally (P = 0.002). Multi-drug resistance (MDR) occurred in 50% and carbapenem resistance in 30% of Acinetobacter spp isolates. In five cases there was panresistance of Acinetobacter spp to all antibiotics tested.
  
  
  CONCLUSIONS
  The trend of increasing numbers of cases of NFGNB in neonatal sepsis compounded by MDR is of great concern. It is necessary to administer antibiotics judiciously, strengthen surveillance and laboratory services in neonatal intensive care units, and re-evaluate treatment guidelines for management of infection by these organisms.
authors.forename: Rajlakshmi
authors.initials: R
authors.lastname: Viswanathan
authors.forename: Arun Kumarendu
authors.initials: AK
authors.lastname: Singh
authors.forename: Sulagna
authors.initials: S
authors.lastname: Basu
authors.forename: Suparna
authors.initials: S
authors.lastname: Chatterjee
authors.forename: Subhasree
authors.initials: S
authors.lastname: Roy
authors.forename: David
authors.initials: D
authors.lastname: Isaacs
mesh_terms: D000332:Aerobiosis; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative bacilli,; Multi-drug resistance,; Neonatal sepsis,; Non-fermenter